The Value Of Virtual Touch Tissue Imaging Quantification In Testicular Sperm Aspiration For Non-obstructive Azoospermia Patients

Objective To explore the value of virtual touch tissue imaging quantification(VTIQ)in testicular sperm aspiration(TESA)for non-obstructive azoospermia(NOA)patients.Methods The clinical information from January 2018 to August 2019,48 patients with NOA were enrolled in andrology of the Affiliated Suzhou Hospital of Nanjing Medical University.Physical examination,reproductive hormone level detection,scrotal ultrasonography and transrectal ultrasonography were performed.The results showed that at least one side of testicular volume was ? 6.0m L.Siemens Acuson Oxana 3 color Doppler ultrasound diagnostic instrument,built-in acoustic radiation force impulse(ARFI)imaging VTIQ technology software were used.48 NOA patients were divided into VTIQ group and conventional ultrasound group.According to testicular volume,they were divided into three subgroups(?6.0 m L and <8.0 m L subgroup,?8.0 m L and < 10.0 m L subgroup,? 10.0m L subgroup).The age,the years of infertility,the puncture side of the testicular volume,follicle-stimulating hormone(FSH),luteinizing hormone(LH),testosterone(T),estradiol(E2)levels in different testicular volume subgroups were compared.Transscrotal ultrasonography was performed before TESA in VTIQ group,and shear wave velocity(SWV)was measured in different areas of bilateral testicular maximum section by VTIQ.Scrotal ultrasonography was performed only in conventional ultrasound group before TESA.In both groups,TESA was performed on the larger side of bilateral testicles.If the volume of bilateral testicles was the same,TESA was performed on the right side of bilateral testicles.In VTIQ group,TESA was performed on the area with the softest tissue hardness under ultrasound guidance according to VTIQ.In conventional ultrasound group,TESA was performed on the thickest part of the middle testicle.Mature sperm was found by embryo laboratory report of reproductive center and sperm was found by pathology department as diagnostic criteria for TESA sperm acquisition.The significant differences in the number of the different testicular volume subgroups were compared.Results There were no significant differences in age,years of infertility,puncture side of the testicular volume,FSH,LH,T and E2 levels among 48 NOA patients in different testicular volume subgroups(P> 0.05).Mature sperm was found by embryo laboratory report of reproductive center and sperm was found by pathology department as diagnostic criteria for TESA sperm acquisition.In 11 patients with testicular volume of ?6.0m L and <8.0m L,there was no significant difference in the number of spermatogenic patients between VTIQ group and conventional ultrasound group(P> 0.05);in 33 patients with testicular volume of ?8.0 m L and < 10.0 m Lsubgroup,there was a significant difference in the number of spermatogenic patients between VTIQ group and conventional ultrasound group(P< 0.05);and in 4 patients with testicular volume of ? 10.0 m L subgroup,there was no significant difference in the number of spermatogenic patients between VTIQ group and conventional ultrasound group(P> 0.05).Conclusion As the third generation of SWV imaging technology,VTIQ has the advantages of noninvasive,easy operation and strong repeatability.VTIQ can objectively reflect the elasticity changes within the organization by providing absolute quantitative indicators of the organization.For testes that may still have a localized spermatogenic area(e.g.testicular volume ?8.0 m L and < 10.0 m L subgroup in this study),VTIQ can provide absolute quantitative indicators of testicular tissue to preliminarily assess testicular spermatogenic function,which provides a new ultrasound perspective for the diagnosis and treatment of NOA patients and broadens the diagnostic criteria of ultrasound.It is helpful to predict the success rate of puncture and semen extraction and to select the puncture path before TESA.